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Title: High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis
Authors: Lobao, R.
Carvalho, A. B.
Cuppari, Lilian [UNIFESP]
Ventura, R.
Lazaretti-Castro, Marise [UNIFESP]
Jorgetti, Vanda [UNIFESP]
Vieira, Jose Gilberto Henriques [UNIFESP]
Cendoroglo, Miguel [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Keywords: pre-dialysis chronic kidney disease
bone mineral density
adynamic bone disease
Issue Date: 1-Dec-2004
Publisher: Dustri-verlag Dr Karl Feistle
Citation: Clinical Nephrology. Deisenhofen-muenchen: Dustri-verlag Dr Karl Feistle, v. 62, n. 6, p. 432-439, 2004.
Abstract: Chronic kidney disease (CKD) leads to reduced bone mineral density (BMD) in pre-dialysis and dialysis patients. A few studies have used dual-energy x-ray absorptiometry (DEXA) to assess BMD in pre-dialysis CKD patients and have shown low BMD to be highly prevalent. Until now there have been no studies reporting the histological features of low BMD in pre-dialysis CKD patients. Aim: To determine the prevalence and histological features of low BMD in pre-dialysis CKD patients. Method: Pre-dialysis CKD patients (n = 103, 46 females/57 males), median creatinine clearance of 29 (10 - 78) ml/min/ 1.73 m(2), were evaluated using biochemical analysis and DEXA. Bone biopsies were obtained from those with low BMD. Results: Fifty (48.5%) out of the 103 patients had low BMD (LBD group) and 53 (51.5%) had normal BMD (NBD group). The risk for low BMD was increased in those patients with alkaline phosphatase levels above 190 U/l and intact-PTH (iPTH) below 70 pg/ml (p < 0.05). Demographic and biochemical parameters from both groups were comparable, except for lower body mass index (BMI) in LBD subjects (p = 0.04). Women who had been post-menopausal for at least I year comprised 65% (13/20) and 50% (13/26) of the LBD and NBD groups, respectively (p = NS). In 40 LBD patients, bone histomorphometry revealed adynamic bone disease (ABD, 52.5%), osteomalacia (OM, 42.5%) and mixed bone disease (MBD, 5%). Trabecular bone volume (BV/TV) was lower in ABD and OM patients. A nearly significant association was found between ABD and iPTH &LE; 150 pg/ml (p = 0.056), whereas higher values of iPTH were associated with OM. Total alkaline phosphatase &LE;190 U/l was significantly associated with ABD, whereas higher values were associated with OM. No correlation was observed between BV/TV and BMD. Conclusion: Low BMD is frequent in pre-dialysis CKD patients, and low turnover bone disease, manifesting as ABD and OM, was the hallmark of this bone loss.
ISSN: 0301-0430
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